Saving Anthony

Nine-year-old Anthony Morales is a different child now that he’s not in restraints, shot up with Thorazine or locked away in a seclusion room of a state children’s psychiatric hospital.

The youngster seemed like any other kid in the Florida Keys as he sat squirming in a plastic chair and concentrating on a Pokemon game on his handheld video console.

“I’m glad to be back in Key West,” he said Wednesday, without missing a play. “I’m glad to see my older brother again.”

His mother — a single mother — watched him fondly as she explained how her son was almost lost to her in the state’s child psychiatric system.

“They restrained him with straitjackets and Thorazine; they told me he was mentally retarded, that he was going to end up in prison,” Hope Estrada said.

That was last year.

Anthony’s troubled behavior — bursts of violent anger, days without sleeping, disruptive behavior documented in his medical records, and multiple Key West police reports and Monroe County sheriff’s dispatch notes — began to surface when he started pre-K in Key West when he was 3½ years old, Estrada said.

“He could not sit still, he was very hyperactive,” Estrada said. “The school district did an evaluation through the Easter Seals and a doctor decided to give him Ritalin.”

The controversial drug is a mild central nervous system stimulant used in the treatment of attention deficit hyperactivity disorder in children, according to Drugs.com. In children, side effects include “loss of appetite … [and] inability to fall or stay asleep,” among others.

That’s not all Anthony experienced.

Bad side effects

“He would drool, suck on his T-shirt, and was very lethargic,” his mother said.

Doctors changed him to Risperdal, an antipsychotic used to treat schizophrenia, mixed and manic states associated with bipolar disorder and irritability in children with autism, the manufacturer’s Web site states.

His behavior didn’t improve. When he was 4, he would run from his mother and refuse to come back. He’d try to strike her and would threaten or attack other children.

This began a series of Baker Act calls to his home. The law allows authorities to detain and commit individuals for temporary mental health evaluation and treatment when required, either on a voluntary or an involuntary basis. He was committed to Miami Children’s Hospital several times, leaving his mother to jump in her car and drive the distance.

“I had to call the police,” she said with tears in her eyes. “I had to have help. The medications were not resolving anything. Some made him hallucinate.”

From age 5 until last summer, when Anthony was 8, he had been committed at least nine times, stabilized and either sent back home or to Sandy Pines, a residential psychiatric treatment center in Palm Beach County. The facility, licensed by the state Agency for Health Care Administration, has a public school, swimming pool, gymnasium and nature trails in a state park that borders the property.

Anthony would live there for six months and receive psychiatric care, counseling and an education. At night, he’d be restricted to the residential treatment unit with other troubled children from around the state. When staff determined he had improved, they’d release him — but the next Baker Act always seemed to come, Estrada said.

It was here that Anthony was restrained, medicated with psychotropic drugs, and isolated in a seclusion ward when he broke down and staff determined he had become violent, Estrada said.

‘A bad place’

“It was a bad place; they stuck needles in me,” Anthony said of his medication, looking up from his video game for a reaction from the adults in the room. “It was scary.”

Five years after Anthony began what his mother calls “a traumatic, emotional roller coaster” of hospital stays and other trouble, a glint of sunlight showed when things were at their worst. Years of driving from Key West to Miami to Palm Beach and back — not to mention the constant worrying about her son’s health and future — Estrada said she heard really bad news.

“On one of his last stays at Sandy Pines, a doctor told me, ‘I don’t know why Anthony is back here because he reached his full potential two months ago. He’s mentally retarded and has no future — except prison,’” Estrada said.

The Florida Department of Children and Families (DCF) said Anthony could not return to Key West because he could not find the help he needed in the community, Estrada said. Not only that, but Anthony was reaching his limit, too. Upon learning that he’d have to return to Sandy Pines, he said something that truly frightened his mother.

The last time Anthony was released to his mother’s care, in July, she had a panic attack and fainted.

Frightened that she’d lose her son to state authorities forever, she started calling lawyers to see what could be done.

Child advocate

“It’s her child, the treatment he was getting was missing the mark and she was crying for help and people weren’t listening,” said Andrea Moore, a lawyer who answered Estrada’s pleas. Moore had been referred by a television consumer advocate reporter Estrada had called.

“I read many of Anthony’s medical records and went to visit Sandy Pines,” Moore said. She met with Sandy Pines staff, with Anthony in the room to see what was going on. “When I first met Anthony, they brought him into a room full of adults at a meeting. He had all the signs of being on psychotropic medication but they let him climb on the tables, climb on the chairs. I was taken aback.”

Moore and the DCF have been alerted to the use of Thorazine, Clonodine and other heavy psychotropic drugs on children as young as Anthony.

It took the suicide of a boy Anthony’s age to shine the spotlight on the practice.

In April 2009, 7-year-old Gabriel Myers hanged himself in his foster parents’ home after years of being on psychotropic drugs, according to a state work group report on the use of the drugs on children. There were many factors that led to his alleged suicide, among them instability in his life and worries about the future, but the drugs are cited as a moving force in his decision to take his life. The work group also found that some 3,000 children had been given the strong drugs without parental permission.

Like Gabriel Myers, Anthony was in trouble, Moore said.

“In my opinion as a child advocate, psychotropic medication in young children is used as chemical restraints, to keep them quiet, calm and really to treat the environment rather than to treat the child,” Moore said.

The Gabriel Myers task force reached the same conclusion about the use of the drugs in child psychiatry. Nationwide, some 5 percent of all children are treated with psychotropic medications, an August 2009 task force reports. “In Florida’s foster care system, 15.2 percent of its children receive at least one such medication.”

The solution?

The bright young boy playing Pokemon still fidgets, but he’s off the heavy medication, Moore said.

“I recommended a thorough neuropsychological battery of tests so we could have an expert determine the best way to treat Anthony,” Moore said. “It was pretty clear that the treatment being provided was missing its mark.”

Moore also requested a PET scan of Anthony’s brain. His skull showed images of a fracture line, the result of falling out of bed when he was 8 months old, Estrada said. Moore thinks that’s where doctors may have gone wrong.

“They didn’t take into account that Anthony may have had organic damage to his brain,” she said.

Anthony is now under the care of a brain injury specialist.

Off medication, Anthony still faces behavioral problems, but has learned coping skills and new ways to get his way using socially acceptable methods, Moore said.

Anthony also was introduced to a different setting to attend school in Hollywood, albeit one that also has seclusion rooms, but does not give Anthtony medication. Known as Florida Palms Academy, it’s one of several alternate family care facilities around the state.

“He had an Individual Education Plan developed for his needs,” Moore said. “He has made incredible progress in school, his behavior has substantially improved and his ability to focus has substantially improved. More importantly, he made progress in reading and math and the other subjects; that was beyond what we would have reasonably anticipated. You can watch him bloom with every passing week.”

There has been action in the Legislature, too. State Sen. Ronda Storms, chair of the Children, Families and Elderly Affairs Committee, has introduced SB 2718, “Relating to Children/Out-of-home Placement/Psychotropic Meds.” If it becomes law, it will require psychiatric evaluation of children and express and informed consent or assent be obtained from a child or the child’s parent or guardian.

Time will tell how much Anthony will improve and whether he’ll do well when he returns to Key West permanently sometime in the next few months. He was in town with his mother Wednesday to see his brother, and perhaps his third-grade teacher at Poinciana Elementary School.